Pathology & Oncology Research

, Volume 13, Issue 3, pp 260–262 | Cite as

Primary bone marrow T-cell anaplastic large cell lymphoma with triple m gradient

  • Árpád Szomor
  • Talal Al Saati
  • Georges Delsol
  • László Kereskai
  • Zsuzsanna Szijártó
  • Hajna Losonczy
Case Report


We present a case of a 60-year-old male patient with primary bone marrow anaplastic large cell lymphoma. He was admitted to the hospital with the symptoms of anemia and fever. There was no evidence of lymphadenopathy or splenomegaly. Immunoelectrophoresis showed the presence of a triple M gradient (double IgM and an IgG), with the IgG and one of the IgM paraproteins functioning as a cryoglobulin. The patient had no hepatitis C virus infection. Bone marrow biopsy showed massive CD30-positive, ALK-negative large lymphoid cell infiltration of T-cell origin with anaplastic morphology. PCR analysis of lymphoid cells separated from the bone marrow demonstrated the presence of a B/T hybrid genotype disorder with no evidence of the t(2;5), nor t(1;2) translocations. The patient entered a period of remission following CHOP chemotherapy. The patient subsequently died of sepsis as a consequence of serious humoral immunodeficiency.

Key words

anaplastic large cell lymphoma T-cell receptor gene rearrangement immunoglobulin heavy chain gene rearrangement M gradient bone marrow 



polymerase chain reaction


immunoglobulin heavy chain


T-cell receptor


reverse transcriptase polymerase chain reaction


anaplastic lymphoma kinase


cyclophosphamide-hydroxy epirubicine-oncovin-pred-nisolone


anaplastic large cell lymphoma


hepatitis C virus


hepatitis B surface antigen


multi-drug resistance


World Health Organization


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  1. 1.
    Falini B, Pileri S, Zinzani PL, Carbone A, Zagonel V, Wolf-Peters CD, Verhoef G, Manestrina F, Tedeschini G, Paulli M, Lazzarino M, Giardini R, Aiello A, Foss HD, Araujo I, Fizzotti M, Pelicci PG, Flenghi L, Martelli MF, Santucci A: ALK+ lym-phoma: clinicopathological findings and outcome. Blood 93: 2697–2706, 1999PubMedGoogle Scholar
  2. 2.
    Garcia MJ, Martinez-Delgado B, Granizo JJ, Benitez J, Rivas C: IgH, TCR-gamma, and TCR-beta gene rearrangement in 80 Band T-cell non-Hodgkin’s lymphomas: study of the associations between proliferation and so-called „aberrant” patterns. Diagn Mol Pathol 10: 69–77, 2001PubMedCrossRefGoogle Scholar
  3. 3.
    Greer JP, Kinney MC, Collins RD, Salhany KE, Wolff SN, Hainsworth JD, Flexner JM, Stein RS: Clinical features of 31 patients with Ki-1 anaplastic large-cell lymphoma. J Clin Oncol 9: 539–547, 1991PubMedGoogle Scholar
  4. 4.
    Lamant L, Meggetto F, Al Saati T, Brugieres L, Paillerets BB, Dastugue N, Bernheim A, Rubie H, Terrier-Lacombe J, Robert A, Brousset P, Rigal F, Schlaifer D, Shiota M, Mori S, Delsol G: High incidence of the t(2;5)(p23;q35) translocation in anaplastic large cell lymphoma and its lack of detection in Hodgkin’s disease. Comparison of cytogenetic analysis, reverse transcriptase-polymerase chain reaction, and P-80 immunostaining. Blood 87: 284–291, 1996PubMedGoogle Scholar
  5. 5.
    Longo G, Federico M, Pieresca C, Avanzini P, Iannito E, Di Prisco AU, Baldini L, Brugiatelli M, Clo V, Bevini M, Silingardi V: Anaplastic large cell lymphoma (CD30+/Ki-1+). Analysis of 35 cases followed at GISL centres. Eur J Cancer 31A: 1763–1767, 1995PubMedCrossRefGoogle Scholar
  6. 6.
    Shulman LN, Frisard N, Antin JH, Wheeler C, Pinkus G, Magauran N, Mauch P, Nobles E, Mashal R, Canellos G, Tung N, Kadin M: Primary Ki-1 anaplastic large-cell lymphoma in adults: clinical characteristics and therapeutic outcome. J Clin Oncol 11:937–942, 1993PubMedGoogle Scholar
  7. 7.
    Stein H, Foss HD, Dürkop H, Marafioti T, Delsol G, Pulford K, Pileri S, Falini B: CD30+ anaplastic large cell lymphoma: a review of its histopathologic, genetic and clinical features. Blood 96: 3681–3695, 2000PubMedGoogle Scholar
  8. 8.
    Szomor Á, Molnár L, Iványi J, Radványi G, Nagy Z, Karádi Á, Gergely L, Bányai A, Demeter J, Aryan H, Gasztonyi Z, Kiss A, Kollár B, Egyed M, Losonczy H, Kelényi G, Pajor L: Extranodal involvement in primary systemic anaplastic large cell lymphoma (ALCL) in adults. Ann Hematol 80: B144–145, 2001CrossRefGoogle Scholar
  9. 9.
    Theriault C, Galoin S, Valmary S, Selves J, Lamant L, Roda D, Rigal-Huguet F, Brousset P, Delsol G, Al Saati T: PCR analysis of immunoglobulin heavy chain (IgH) and TcR-gamma chain rearrangements in the diagnosis of lymphoproliferative disorders of a study of 525 cases. Mod Pathol 13: 1269–1279, 2000PubMedCrossRefGoogle Scholar
  10. 10.
    Tilly H, Gaulard P, Lepage E, Dumontet C, Diebold J, Plantier I, Berger F, Symann M, Pertella T, Lederlin P, Briere J: Primary anaplastic large-cell lymphoma in adults: clinical presentation, immunophenotype, and outcome. Blood 90: 3727–3734, 1997PubMedGoogle Scholar
  11. 11.
    Zinzani PL, Bendandi M, Martelli M, Falini B, Sabattini E, Amadori S, Gherlinzoni F, Martelli MF, Mandelli F, Tura S, Pileri SA: Anaplastic large-cell lymphoma: prognostic evaluation of 90 adult patients. J Clin Oncol 14: 955–962, 1996PubMedGoogle Scholar

Copyright information

© Arányi Lajos Foundation 2007

Authors and Affiliations

  • Árpád Szomor
    • 1
  • Talal Al Saati
    • 4
  • Georges Delsol
    • 4
  • László Kereskai
    • 2
  • Zsuzsanna Szijártó
    • 3
  • Hajna Losonczy
    • 1
  1. 1.1st Department of MedicineUniversity of PécsPécsHungary
  2. 2.Institute of PathologyUniversity of PécsHungary
  3. 3.Department of OphthalmologyUniversity of PécsHungary
  4. 4.Laboratory of Anatomic PathologyCentral Hospital University PurpanToulouseFrance

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